Observation of changes after peripheral retinal injury by cosmetic laser, using wide-field scanning laser ophthalmoscope

Abstract

Rationale: Increases in cosmetic laser use have led to recent reports of accidental retinal injuries, most of which are limited to the posterior pole. We report a case of peripheral retinal injury caused by a 1064-nm Nd:YAG: neodymium-doped yttrium aluminum garnet. Patient concerns: A 27-year-old Asian woman was admitted with scotoma symptoms in her right eye. The patient was a skin care technician. Three days before admission, a laser beam had struck her eye while she was preparing for a laser procedure. Diagnosis: During fundus examination, a subretinal hemorrhage with disc diameter (DD) of 4.0 and a preretinal hemorrhage of 2.5 DD in its center were found in the 2 o’clock position of the peripheral retina in the right eye. Interventions: We monitored the injury for > 6 months, first using fluorescein angiography, then wide-field scanning laser ophthalmoscopy and optical coherence tomography. Oral steroids and vitamins were administered. Outcomes: During the 6-month follow-up period, blood from the initial sub- and preretinal hemorrhage, as well as vitreous hemorrhage, were all absorbed. Retinal detachment was not observed as scar formation and adhesions had occurred. No interventions were considered necessary. Lessons: When treating a patient who has experienced laser eye injury, the possibility of peripheral retinal injury should be considered. Peripheral retinal injury caused by 1064-nm Nd:YAG: neodymium-doped yttrium aluminum garnet has a relatively good prognosis, suggesting that it will not progress to retinal detachment.

Cosmetic Laser Related Retinal Injuries

“…Cosmetic laser related eye injury was rare, and as an occupational hazard to the laser operating personnel was even rarer. Four case reports were found for cosmetic laserinduced retinal injury [9][10][11][12]. Their clinical histories and outcomes were summarized in Table 1.…”

“…Their clinical histories and outcomes were summarized in Table 1. Three out of 4 patients had peripheral retinal injuries [9][10][11]. The initial symptoms were due to vitreous and retinal hemorrhage, and had remarkable recovery of vision without any surgical intervention [9][10][11].…”

“…When laser is applied for cosmetics, the close proximity of the handheld probe to the ocular adnexa is at risk of jeopardizing the retina due to non-dispersed beam through the translucent cornea, lens and vitreous. Cases of cosmetic laser induced peripheral retinal injuries had been rarely reported (Chen, Shum, Kim) and all vision had recovered without intervention [9][10][11].…”

Retinal toxicity after facial laser epilation

“…Laser-impenetrable metal corneal shields can be fit as contact lenses over the patient's corneas but they do not exempt the operator of wearing laser goggles. Two case reports of retinal injuries produced by Nd:YAG laser affecting the operating aesthetician have been published so far [6,7]. In both of them, the operator was either not wearing eye protection at all [6] or wearing regular sunglasses [7].…”

“…Two case reports of retinal injuries produced by Nd:YAG laser affecting the operating aesthetician have been published so far [6,7]. In both of them, the operator was either not wearing eye protection at all [6] or wearing regular sunglasses [7].…”